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Crooks AV, Hsue W, Tschabrunn CM, Gelzer AR. Feasibility of electroanatomic mapping and radiofrequency catheter ablation in Boxer dogs with symptomatic ventricular tachycardia. J Vet Intern Med 2022; 36:886-896. [PMID: 35307868 PMCID: PMC9151449 DOI: 10.1111/jvim.16412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Treatment for Boxers with ventricular tachycardia (VT) is limited. Electroanatomic mapping (EAM) facilitates identification of arrhythmogenic substrate for radiofrequency catheter ablation (RFCA). Objective Describe the use of EAM to guide RFCA in Boxers with VT. Animals Five client‐owned Boxers with symptomatic VT or persistent VT despite antiarrhythmic medications. Methods Case series evaluating clinical, EAM, and before and after RFCA Holter data. Results Sustained VT was inducible in 3 dogs, but required aggressive stimulation protocols. Low‐voltage areas consistent with electroanatomic scar were found in 2 dogs, located at the right ventricular (RV) outflow tract and cranial RV. Two dogs had a focal activation pattern of VT and 1 dog had a reentrant mechanism. After RFCA, all dogs no longer collapsed and had fewer runs of VT, 3 of which had 0 runs of VT. Number of ventricular premature beats increased in 3 dogs and decreased in 2 dogs, 1 of which had nearly complete resolution of all arrhythmias. Procedural complications included ventricular fibrillation (n = 2) with successful defibrillation, bruising or hemorrhage at the vascular access site (n = 4), retroperitoneal hemorrhage (n = 1), aortic and mitral regurgitation (n = 1), onset of frequent supraventricular tachycardia (n = 1), and persistent right pelvic limb lameness (n = 1). Conclusions and Clinical Importance Electroanatomic mapping and RFCA are feasible in Boxers with VT. Based on this small cohort, RFCA may help decrease runs of VT and improve clinical signs. The anatomic substrate and electrophysiologic mechanisms are variable and require further study.
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Affiliation(s)
- Alexandra V. Crooks
- Department of Clinical Sciences and Advanced Medicine School of Veterinary Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Weihow Hsue
- Department of Clinical Sciences and Advanced Medicine School of Veterinary Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
| | - Cory M. Tschabrunn
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
| | - Anna R. Gelzer
- Department of Clinical Sciences and Advanced Medicine School of Veterinary Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
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Aryal SR, Bajaj NS, Von Mering G, Ahmed MI. The role of multimodality imaging in HIV-related heart disease. J Nucl Cardiol 2021; 28:531-535. [PMID: 32820425 DOI: 10.1007/s12350-020-02291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Sudeep Raj Aryal
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Navkaranbir S Bajaj
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gregory Von Mering
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Structural Heart & Valve Clinic at Spain Wallace, 619 19th Street South, Birmingham, AL, 35233, USA
| | - Mustafa I Ahmed
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL, USA
- UAB Structural Heart & Valve Clinic at Spain Wallace, 619 19th Street South, Birmingham, AL, 35233, USA
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Mondal P, Aljizeeri A, Small G, Malhotra S, Harikrishnan P, Affandi JS, Buechel RR, Dwivedi G, Al-Mallah MH, Jain D. Coronary artery disease in patients with human immunodeficiency virus infection. J Nucl Cardiol 2021; 28:510-530. [PMID: 32820424 DOI: 10.1007/s12350-020-02280-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/01/2020] [Indexed: 01/02/2023]
Abstract
The life expectancy of people infected with human immunodeficiency virus (HIV) is rising due to better access to combination anti-retroviral therapy (ART). Although ART has reduced acquired immune deficiency syndrome (AIDS) related mortality and morbidity, there has been an increase in non-AIDS defining illnesses such as diabetes mellitus, hypercholesterolemia and coronary artery disease (CAD). HIV is a disease marked by inflammation which has been associated with specific biological vascular processes increasing the risk of premature atherosclerosis. The combination of pre-existing risk factors, atherosclerosis, ART, opportunistic infections and coagulopathy contributes to rising CAD incidence. The prevalence of CAD has emerged as a major contributor of morbidity in these patients due to longer life expectancy. However, ART has been associated with lipodystrophy, dyslipidemia, insulin resistance, diabetes mellitus and CAD. These adverse effects, along with drug-drug interactions when ART is combined with cardiovascular drugs, result in significant challenges in the care of this group of patients. Exercise tolerance testing, echocardiography, myocardial perfusion imaging, coronary computed tomography angiography and magnetic resonance imaging help in the diagnosis of CAD and heart failure and help predict cardiovascular outcomes in a manner similar to non-infected individuals. This review will highlight the pathogenesis and factors that link HIV to CAD, presentation and treatment of HIV-patients presenting with CAD and review briefly the cardiac imaging modalities used to identify this entity and help prognosticate future outcomes.
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Affiliation(s)
- Pratik Mondal
- Department of Cardiology and Nuclear Cardiovascular Imaging Laboratory, New York Medical College, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA
| | - Ahmed Aljizeeri
- King Abdulaziz Cardiac Center, Ministry of National Guard-Health Affaire, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Gary Small
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
| | | | | | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Girish Dwivedi
- Fiona Stanley Hospital, Murdoch, WA, Australia
- Harry Perkins Institute of Medical Research, Murdoch, WA, Australia
- The University of Western Australia, Crawley, WA, Australia
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Diwakar Jain
- Department of Cardiology and Nuclear Cardiovascular Imaging Laboratory, New York Medical College, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA.
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Saidova MA, Loskutova AS, Belevskaya AA, Stukalova OV. [The assessment of right ventricular structure and function in patients with different cardiovascular diseases using modern echocardiographic technologies and magnetic resonance imaging]. TERAPEVT ARKH 2020; 92:24-29. [PMID: 33346427 DOI: 10.26442/00403660.2020.09.000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
AIM To perform comparative analysis of right ventricular (RV) structure and function in patients with various cardiovascular diseases using modern echocardiographic technologies in comparison with magnetic resonance imaging (MRI). MATERIALS AND METHODS The study included 85 patients. Group 1 consisted of 32 patients with idiopathic pulmonary hypertension (IPH) (mean age 35.910.2 years). Group 2 included 27 patients with arterial hypertension (AH) grade 3 (mean age 58.612.3 years). Group 3 consisted of 26 patients with chronic heart failure (CHF) (mean age 56.115.3 years). Control group included 28 healthy volunteers (mean age 38.710.9 years). The main method was transthoracic echocardiography (TTE) using modern technologies, such as three-dimensional echocardiography (3DE), tissue Doppler imaging (TDI), and speckle tracking echocardiography (STE). In some patients and healthy volunteers 3DE data were compared with MRI data. RESULTS Patients with IPH and CHF had minimal RV ejection fraction (EF) both according to 3DE and MRI. Correlation analysis revealed close correlation between RV volumes and EF according to 3DE and MRI. Minimal values of systolic indicator STV according to TDI were observed in patients with CHF. In all groups, including control group, the highest values of STV were obtained at the level of the basal segments and the lowest values at the level of apical segments. STE revealed the same pattern as TDI. According to STE minimal RV strain was observed in IPH and CHF groups and significantly differed not only from control group, but also from AH group. CONCLUSION The lowest values of RV EF and strain were observed in IPH and CHF groups. There were no significant differences in these indicators between the groups, that dictates the need for thorough assessment of RV structure and function not only in patients with precapillary, but also with postcapillary pulmonary hypertension. The results of the study confirm good comparability of 3DE and MRI in assessing RV volumes and EF.
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Affiliation(s)
- M A Saidova
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | | | - A A Belevskaya
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | - O V Stukalova
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
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Coulden RA, Sonnex EP, Abele JT, Crean AM. Utility of FDG PET and Cardiac MRI in Diagnosis and Monitoring of Immunosuppressive Treatment in Cardiac Sarcoidosis. Radiol Cardiothorac Imaging 2020; 2:e190140. [PMID: 33778595 DOI: 10.1148/ryct.2020190140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 04/02/2020] [Accepted: 04/09/2020] [Indexed: 11/11/2022]
Abstract
Purpose To compare the contributions of cardiac MRI and PET in the diagnosis and management of cardiac sarcoidosis (CS), with particular reference to quantitative measures. Materials and Methods This is a retrospective, observational study of 31 patients (mean age, 45.7 years) with proven extracardiac sarcoidosis and possible CS who were investigated with fluorine 18 fluorodeoxyglucose (FDG) PET/CT and cardiac MRI. Patients were treated at physicians' discretion with repeat combined imaging after an interval of 102-770 days (median, 228 days). Results Significant myocardial FDG uptake was shown on visit 1 (myocardial maximum standardized uptake value [SUVmax] > 3.6) in 17 of 22 patients who were subsequently treated. Myocardial SUVmax decreased at follow-up (6.5 to 4.0; P < .01) and was matched by significant decreases in FDG-avid lung and mediastinal node disease. A volumetric measure of myocardium above a threshold SUV (cardiac metabolic volume) decreased from a mean of 42.5 to a mean of 4.1 (P < .001). This was associated with significant improvement in the left ventricular ejection fraction (LVEF) (45.8 increasing to 50.9; P < .031). There was no change in volume of late gadolinium enhancement at treatment. Patients who were untreated showed no change in any FDG PET or cardiac MRI parameter. Conclusion Myocardial FDG uptake in patients suspected of having CS is presumed to represent active inflammation. When treated with corticosteroids, this resolved or regressed at follow-up, with an improvement in LVEF and FDG-avid thoracic disease. Patients who were untreated showed no change in any parameter. Quantification of FDG-avid myocardium using cardiac metabolic volume is proposed as a useful objective measure for assessing response to therapy.© RSNA, 2020See also commentary by Gutberlet in this issue.
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Affiliation(s)
- Richard A Coulden
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, Canada T6G 2B7 (R.A.C., E.P.S., J.T.A.); and Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (A.M.C.)
| | - Emer P Sonnex
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, Canada T6G 2B7 (R.A.C., E.P.S., J.T.A.); and Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (A.M.C.)
| | - Jonathan T Abele
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, Canada T6G 2B7 (R.A.C., E.P.S., J.T.A.); and Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (A.M.C.)
| | - Andrew M Crean
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, Canada T6G 2B7 (R.A.C., E.P.S., J.T.A.); and Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (A.M.C.)
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Pellikka PA, Arruda-Olson A, Chaudhry FA, Chen MH, Marshall JE, Porter TR, Sawada SG. Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography. J Am Soc Echocardiogr 2020; 33:1-41.e8. [DOI: 10.1016/j.echo.2019.07.001] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Anderson RD, Lee G, Trivic I, Campbell T, Pham T, Nalliah C, Kizana E, Thomas SP, Trivedi SJ, Watts T, Kalman J, Kumar S. Focal Ventricular Tachycardias in Structural Heart Disease: Prevalence, Characteristics, and Clinical Outcomes After Catheter Ablation. JACC Clin Electrophysiol 2019; 6:56-69. [PMID: 31971907 DOI: 10.1016/j.jacep.2019.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/29/2019] [Accepted: 09/04/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study sought to summarize the procedural characteristics and outcomes of patients with structural heart disease (SHD) who have focal ventricular tachycardia (VT). BACKGROUND Scar-mediated re-entry is the predominant mechanism of VT in SHD. Some SHD patients may have a focal VT mechanism that remains poorly described. METHODS An extended induction protocol incorporating programmed electrical stimulation, right ventricular burst pacing and isoprenaline was used to elucidate both re-entrant and focal VT mechanisms. RESULTS Eighteen of 112 patients (16%) with SHD undergoing VT ablation over 2 years had a focal VT mechanism elucidated (mean age 66±13 years; ejection fraction 46±14%; nonischemic cardiomyopathy 10). Repetitive failure of termination with antitachycardia pacing (ATP) (69% of patients) or defibrillator shocks (56%) was a common feature of focal VTs. A median of 3 VTs per patient were inducible (28 focal VTs, 34 re-entrant VTs; 53% of patients had both focal and re-entrant VT mechanism). Focal VTs more commonly originated from the right ventricle (RV) than the left ventricle (LV) (67% vs. 33%, respectively). In the RV, the RV outflow tract was the most common site (33% of all focal VTs), followed by the RV moderator band (22%), apical septal RV (6%), and lateral tricuspid annulus (6%). The lateral LV (non-Purkinje) was the most common LV focal VT site (16%), followed by the papillary muscles (17%). After median follow-up of 289 days, 78% of patients remained arrhythmia-free; no patients had recurrence of focal VT at repeat procedure. In patients with recurrence, defibrillator therapies were significantly reduced from a median of 53 ATP episodes pre-ablation to 10 ATP episodes post-ablation. During follow-up, 2 patients (11%) underwent repeat VT ablation; none had recurrence of focal VT. CONCLUSIONS Focal VTs are common in patients with SHD and often coexist with re-entrant forms of VT. High failure rate of defibrillator therapies was a common feature of focal VT mechanisms. Uncovering and abolishing focal VT may further improve outcomes of catheter ablation in SHD.
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Affiliation(s)
- Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Australia
| | - Ivana Trivic
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Timmy Pham
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Eddy Kizana
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Stuart P Thomas
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Siddharth J Trivedi
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Troy Watts
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Australia
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia.
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Rudski LG, Gargani L, Armstrong WF, Lancellotti P, Lester SJ, Grünig E, D'Alto M, Åström Aneq M, Ferrara F, Saggar R, Saggar R, Naeije R, Picano E, Schiller NB, Bossone E. Stressing the Cardiopulmonary Vascular System: The Role of Echocardiography. J Am Soc Echocardiogr 2018; 31:527-550.e11. [PMID: 29573927 DOI: 10.1016/j.echo.2018.01.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 01/06/2023]
Abstract
The cardiopulmonary vascular system represents a key determinant of prognosis in several cardiorespiratory diseases. Although right heart catheterization is considered the gold standard for assessing pulmonary hemodynamics, a comprehensive noninvasive evaluation including left and right ventricular reserve and function and cardiopulmonary interactions remains highly attractive. Stress echocardiography is crucial in the evaluation of many cardiac conditions, typically coronary artery disease but also heart failure and valvular heart disease. In stress echocardiographic applications beyond coronary artery disease, the assessment of the cardiopulmonary vascular system is a cornerstone. The possibility of coupling the left and right ventricles with the pulmonary circuit during stress can provide significant insight into cardiopulmonary physiology in healthy and diseased subjects, can support the diagnosis of the etiology of pulmonary hypertension and other conditions, and can offer valuable prognostic information. In this state-of-the-art document, the topic of stress echocardiography applied to the cardiopulmonary vascular system is thoroughly addressed, from pathophysiology to different stress modalities and echocardiographic parameters, from clinical applications to limitations and future directions.
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Affiliation(s)
- Lawrence G Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - William F Armstrong
- Department of Internal Medicine, Division of Cardiovascular Disease, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA-Cardiovascular Sciences, Liège, Belgium
| | - Steven J Lester
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, University Hospital Heidelberg, Heidelberg, Germany
| | - Michele D'Alto
- Department of Cardiology, Second University of Naples-Monaldi Hospital, Naples, Italy
| | - Meriam Åström Aneq
- Department of Clinical Physiology, Institution of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Rajeev Saggar
- Lung Institute, Banner University Medical Center-Phoenix, University of Arizona, Phoenix, Arizona
| | - Rajan Saggar
- Lung & Heart-Lung Transplant and Pulmonary Hypertension Programs, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | | | - Eugenio Picano
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Nelson B Schiller
- Cardiovascular Research Institute, Health eHeart Study, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California
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Abstract
Coronary artery disease (CAD) continues to be a leading cause of morbidity and mortality worldwide. Although invasive coronary angiography has previously been the gold standard in establishing the diagnosis of CAD, there is a growing shift to more appropriately use the cardiac catheterization laboratory to perform interventional procedures once a diagnosis of CAD has been established by noninvasive imaging modalities rather than using it primarily as a diagnostic facility to confirm or refute CAD. With ongoing technological advancements, noninvasive imaging plays a pre-eminent role in not only diagnosing CAD but also informing the choice of appropriate therapies, establishing prognosis, all while containing costs and providing value-based care. Multiple imaging modalities are available to evaluate patients suspected of having coronary ischemia, such as stress electrocardiography, stress echocardiography, single-photon emission computed tomography myocardial perfusion imaging, positron emission tomography, coronary computed tomography (CT) angiography, and magnetic resonance imaging. These imaging modalities can variably provide functional and anatomical delineation of coronary stenoses and help guide appropriate therapy. This review will discuss their advantages and limitations and their usage in the diagnostic pathway for patients with CAD. We also discuss newer technologies such as CT fractional flow reserve, CT angiography with perfusion, whole-heart coronary magnetic resonance angiography with perfusion, which can provide both anatomical as well as functional information in the same test, thus obviating the need for multiple diagnostic tests to obtain a comprehensive assessment of both, plaque burden and downstream ischemia. Recognizing that clinicians have a multitude of tests to choose from, we provide an underpinning of the principles of ischemia detection by these various modalities, focusing on anatomy vs physiology, the database justifying their use, their prognostic capabilities and lastly, their appropriate and judicious use in this era of patient-centered, cost-effective imaging.
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10
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Quantification of Right Ventricular Volume and Function Using Single-Beat Three-Dimensional Echocardiography: A Validation Study with Cardiac Magnetic Resonance. J Am Soc Echocardiogr 2016; 29:392-401. [DOI: 10.1016/j.echo.2016.01.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Indexed: 11/22/2022]
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Case BC, Zemedkun M, Sangkharat A, Taylor AJ, Srichai MB. Pulmonary Embolism Diagnosed From Right Heart Changes Seen After Exercise Stress Echocardiography. Circ Cardiovasc Imaging 2015. [DOI: 10.1161/circimaging.115.003506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brian C. Case
- From the Department of Internal Medicine (B.C.C.), Department of Cardiology, Medstar Washington Hospital Center (M.Z.), Department of Internal Medicine (A.S.), and Medstar Heart and Vascular Institute (A.J.T., M.B.S.), Medstar Georgetown University Hospital, Washington, DC
| | - Micheas Zemedkun
- From the Department of Internal Medicine (B.C.C.), Department of Cardiology, Medstar Washington Hospital Center (M.Z.), Department of Internal Medicine (A.S.), and Medstar Heart and Vascular Institute (A.J.T., M.B.S.), Medstar Georgetown University Hospital, Washington, DC
| | - Amarin Sangkharat
- From the Department of Internal Medicine (B.C.C.), Department of Cardiology, Medstar Washington Hospital Center (M.Z.), Department of Internal Medicine (A.S.), and Medstar Heart and Vascular Institute (A.J.T., M.B.S.), Medstar Georgetown University Hospital, Washington, DC
| | - Allen J. Taylor
- From the Department of Internal Medicine (B.C.C.), Department of Cardiology, Medstar Washington Hospital Center (M.Z.), Department of Internal Medicine (A.S.), and Medstar Heart and Vascular Institute (A.J.T., M.B.S.), Medstar Georgetown University Hospital, Washington, DC
| | - Monvadi B. Srichai
- From the Department of Internal Medicine (B.C.C.), Department of Cardiology, Medstar Washington Hospital Center (M.Z.), Department of Internal Medicine (A.S.), and Medstar Heart and Vascular Institute (A.J.T., M.B.S.), Medstar Georgetown University Hospital, Washington, DC
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Kukulski T, She L, Racine N, Gradinac S, Panza JA, Velazquez EJ, Chan K, Petrie MC, Lee KL, Pellikka PA, Romanov A, Biernat J, Rouleau JL, Batlle C, Rogowski J, Ferrazzi P, Zembala M, Oh JK. Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. J Thorac Cardiovasc Surg 2014; 149:1312-21. [PMID: 25451487 DOI: 10.1016/j.jtcvs.2014.09.117] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/03/2014] [Accepted: 09/28/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. METHODS Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35% or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point. RESULTS Right ventricular dysfunction was mild in 102 patients (12%) and moderate or severe in 78 patients (9%). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P < .0001) compared with normal or mildly reduced right ventricular function. A significant interaction between right ventricular dysfunction and treatment allocation was observed. Patients with moderate or severe right ventricular dysfunction who received coronary artery bypass grafting + surgical ventricular reconstruction had significantly worse outcomes compared with patients who received coronary artery bypass grafting alone on both the primary (hazard ratio, 1.86; confidence interval, 1.06-3.26; P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality (P = .022). CONCLUSIONS Adding surgical ventricular reconstruction to coronary artery bypass grafting may worsen long-term survival in patients with ischemic cardiomyopathy with moderate to severe right ventricular dysfunction, which reflects advanced left ventricular remodeling.
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Affiliation(s)
- Tomasz Kukulski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland.
| | - Lilin She
- Duke Clinical Research Institute, Durham, NC
| | - Normand Racine
- Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Canada
| | | | | | - Eric J Velazquez
- Duke Clinical Research Institute, Durham, NC; Department of Medicine-Cardiology, Duke University School of Medicine, Durham, NC
| | - Kwan Chan
- University of Ottawa Heart Institute, Ottawa, Canada
| | | | - Kerry L Lee
- Duke Clinical Research Institute, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | | | | | | | - Jean L Rouleau
- Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Canada
| | | | | | | | - Marian Zembala
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland
| | - Jae K Oh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
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Supariwala AA, Po JRF, Mohareb S, Aslam F, Kaddaha F, Mian ZI, Chaudhry F, Otokiti A, Chaudhry FA. Prevalence and Long-Term Prognosis of Patients with Complete Bundle Branch Block (Right or Left Bundle Branch) with Normal Left Ventricular Ejection Fraction Referred for Stress Echocardiography. Echocardiography 2014; 32:483-9. [DOI: 10.1111/echo.12680] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Azhar A. Supariwala
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Jose Ricardo F. Po
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Sameh Mohareb
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Farhan Aslam
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Firas Kaddaha
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Zainab I. Mian
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Farhan Chaudhry
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Ahmed Otokiti
- Mount Sinai St. Luke's and Roosevelt; Icahn School of Medicine at Mount Sinai; New York New York
| | - Farooq A. Chaudhry
- Mount Sinai Hospital; Icahn School of Medicine at Mount Sinai; New York New York
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Mieres JH, Gulati M, Bairey Merz N, Berman DS, Gerber TC, Hayes SN, Kramer CM, Min JK, Newby LK, Nixon JVI, Srichai MB, Pellikka PA, Redberg RF, Wenger NK, Shaw LJ. Role of noninvasive testing in the clinical evaluation of women with suspected ischemic heart disease: a consensus statement from the American Heart Association. Circulation 2014; 130:350-79. [PMID: 25047587 DOI: 10.1161/cir.0000000000000061] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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15
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Right Ventricular Involvement in Coronary Artery Disease: Role of Echocardiography for Diagnosis and Prognosis. J Am Soc Echocardiogr 2014; 27:223-9. [DOI: 10.1016/j.echo.2013.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Indexed: 11/17/2022]
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16
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Qin X, Cong Z, Fei B. Automatic segmentation of right ventricular ultrasound images using sparse matrix transform and a level set. Phys Med Biol 2013; 58:7609-24. [PMID: 24107618 DOI: 10.1088/0031-9155/58/21/7609] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
An automatic segmentation framework is proposed to segment the right ventricle (RV) in echocardiographic images. The method can automatically segment both epicardial and endocardial boundaries from a continuous echocardiography series by combining sparse matrix transform, a training model, and a localized region-based level set. First, the sparse matrix transform extracts main motion regions of the myocardium as eigen-images by analyzing the statistical information of the images. Second, an RV training model is registered to the eigen-images in order to locate the position of the RV. Third, the training model is adjusted and then serves as an optimized initialization for the segmentation of each image. Finally, based on the initializations, a localized, region-based level set algorithm is applied to segment both epicardial and endocardial boundaries in each echocardiograph. Three evaluation methods were used to validate the performance of the segmentation framework. The Dice coefficient measures the overall agreement between the manual and automatic segmentation. The absolute distance and the Hausdorff distance between the boundaries from manual and automatic segmentation were used to measure the accuracy of the segmentation. Ultrasound images of human subjects were used for validation. For the epicardial and endocardial boundaries, the Dice coefficients were 90.8 ± 1.7% and 87.3 ± 1.9%, the absolute distances were 2.0 ± 0.42 mm and 1.79 ± 0.45 mm, and the Hausdorff distances were 6.86 ± 1.71 mm and 7.02 ± 1.17 mm, respectively. The automatic segmentation method based on a sparse matrix transform and level set can provide a useful tool for quantitative cardiac imaging.
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Affiliation(s)
- Xulei Qin
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30329, USA
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17
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Velasco-Sanchez D, Lambert R, Turpin S, Laforge S, Fournier A, Lapierre C, Dahdah N. Right ventricle myocardial perfusion scintigraphy: feasibility and expected values in children. Pediatr Cardiol 2012; 33:295-301. [PMID: 21968577 DOI: 10.1007/s00246-011-0128-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 09/12/2011] [Indexed: 11/24/2022]
Abstract
Stress myocardial perfusion scintigraphy imaging (SMPSI) has important applications for evaluating coronary disease and ventricular function. Studies consistently focus on the left ventricle (LV), with no normal right ventricle (RV) data available. This study sought to evaluate the feasibility of RV perfusion with technetium (Tc-99m) sestamibi using a low radiotracer dose for children free of coronary artery (CA) anomalies and to determine its normal pattern. Patients with a history of Kawasaki disease who showed no coronary complications on selective angiography or no LV perfusion defects on SMPSI were studied at rest and during an exercise challenge. The RV uptake counts were compared with those for different segments of the LV, and multiple ratios of the uptakes between RV and LV segments were calculated. The study subjects were 23 children (age, 11.1 ± 3.3 years) imaged with 0.12 ± 0.03 mCi/kg at rest and 0.31 ± 0.06 mCi/kg during stress. The RV to LV uptake proportion was approximately 6%. Exercise-related uptake increased threefold in both the RV and the LV. The findings showed RV myocardial scintigraphy to be feasible with reproducible ratios. Potential clinical applications include acquired and congenital CA anomalies such as Kawasaki disease, right CA ostium stenosis after a switch operation, and anomalous origin of the right CA.
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18
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Wever-Pinzon O, Bangalore S, Romero J, Enciso JS, Chaudhry FA. Inotropic contractile reserve can risk-stratify patients with HIV cardiomyopathy: a dobutamine stress echocardiography study. JACC Cardiovasc Imaging 2011; 4:1231-8. [PMID: 22172778 PMCID: PMC3595113 DOI: 10.1016/j.jcmg.2011.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 09/07/2011] [Accepted: 09/09/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES The purpose of this study was to assess whether inotropic contractile reserve (ICR) during dobutamine stress echocardiography (DSE) could risk-stratify patients with human immunodeficiency virus (HIV) cardiomyopathy and predict improvement of left ventricular ejection fraction (LVEF). BACKGROUND HIV cardiomyopathy is an important cause of heart failure and death. ICR is associated with better survival and improvement of LVEF in patients with ischemic and nonischemic cardiomyopathies. However, the prognostic value of ICR in patients with HIV cardiomyopathy is unknown. METHODS Patients with HIV cardiomyopathy and a LVEF <45% who were referred for DSE were enrolled. ICR was evaluated by the delta wall motion score index (ΔWMSI), calculated as the difference between rest and peak WMSI. Patients were followed for cardiac death and change in LVEF on follow-up. RESULTS Sixty patients (75% men; age, 54 ± 9 years) with HIV cardiomyopathy (mean LVEF, 28 ± 11%) formed the study group. After 2.4 ± 2.1 years, 11 cardiac deaths occurred (event rate of 7.6%/year). A receiver-operating characteristic curve identified a ΔWMSI of 0.38 as an optimal cut point for the presence of ICR, with a specificity of 88% and a sensitivity of 73% for the prediction of cardiac death. On univariable analysis, the absence of ICR (hazard ratio: 6.6; 95% confidence interval: 1.93 to 22.62; p = 0.003) and New York Heart Association functional class IV (hazard ratio: 7.2; 95% confidence interval: 2.20 to 23.65; p = 0.001) were the only predictors of cardiac death. After 2.1 ± 1.8 years, 41 patients had a follow-up echocardiogram. LVEF improvement from baseline occurred in 23 patients (56%), more so in patients with ICR than without ICR. A ΔWMSI of 0.59 predicted improvement in the LVEF with a specificity of 78% and a sensitivity of 74%. CONCLUSIONS The presence of ICR during DSE can risk-stratify and predict subsequent improvement in LVEF in patients with HIV cardiomyopathy.
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Affiliation(s)
- Omar Wever-Pinzon
- St. Luke’s Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Jorge Romero
- St. Luke’s Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York
| | - Jorge Silva Enciso
- St. Luke’s Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York
| | - Farooq A. Chaudhry
- St. Luke’s Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York
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Wever Pinzon O, Silva Enciso J, Romero J, Makani H, Fefer J, Gandhi V, Bangalore S, Chaudhry FA. Risk stratification and prognosis of human immunodeficiency virus-infected patients with known or suspected coronary artery disease referred for stress echocardiography. Circ Cardiovasc Imaging 2011; 4:363-70. [PMID: 21750273 PMCID: PMC3593109 DOI: 10.1161/circimaging.110.961060] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with human immunodeficiency virus (HIV) infection are at increased risk of accelerated coronary artery disease (CAD) and cardiovascular events. Stress echocardiography (SE) is routinely used for risk stratification and prognosis of patients with known or suspected CAD. The prognostic value of SE in this high-risk group is unknown. The purpose of this study was to evaluate the prognostic value of SE in HIV-infected patients with known or suspected CAD. METHODS AND RESULTS We evaluated 311 patients (age, 52 ± 9 years; 74% men; left ventricular ejection fraction, 54 ± 12%) with history of HIV, undergoing SE (56% dobutamine). Left ventricular wall motion was evaluated on a 16-segment model, 5-point scale. An abnormal SE was defined by a fixed (infarction), biphasic, or new (ischemia) wall motion abnormality on stress. Follow-up for cardiac death and myocardial infarction was obtained. Seventy-nine (26%) patients had an abnormal SE. After 2.9 ± 1.9 years, 17 confirmed myocardial infarction and 14 cardiac deaths occurred. SE risk-stratified patients into normal versus abnormal subgroups (event rate, 0.6% per year versus 11.8% per year; P < 0.0001). Both abnormal SE (hazard ratio, 28.2; 95% confidence interval, 6.2 to 128.0; P < 0.0001) and the presence of any ischemia on SE (hazard ratio, 3.4; 95% confidence interval, 1.3 to 8.6; P = 0.009) were independent predictors of cardiac events. On a forward conditional Cox proportional hazards regression model, SE provided incremental prognostic value over clinical, stress ECG, and resting echocardiographic variables (global χ(2) increased from 17.8 to 24.5 to 65 to 109, P < 0.05 across all groups). CONCLUSIONS SE can effectively risk-stratify and prognosticate patients with HIV. The presence of ischemia and scar during SE provides independent and incremental prognostic value over traditional variables. A normal SE response portends a benign prognosis even in this high-risk subset.
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The concept of ventricular reserve in heart failure and pulmonary hypertension: an old metric that brings us one step closer in our quest for prediction. Curr Opin Cardiol 2011; 26:123-31. [PMID: 21297465 DOI: 10.1097/hco.0b013e3283437485] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Ventricular reserve is emerging a strong predictor of outcome in heart failure and cardiovascular disease. Ventricular reserve is the term used to describe the extent of increase or change in ventricular function that occurs during exercise or pharmacological stress (typically with dobutamine). RECENT FINDINGS The interest in ventricular reserve lies in its ability to assess viability in coronary artery disease, to predict clinical outcome and response to therapy in patients with heart failure and to screen patients for early cardiovascular disease. SUMMARY In this paper, we will review the emerging role of ventricular reserve in heart failure and pulmonary hypertension. We will also explore the mechanisms involved in the pathophysiology of impaired ventricular reserve and discuss future directions of research in the field.
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Fine NM, Pellikka PA. Stress echocardiography for the detection and assessment of coronary artery disease. J Nucl Cardiol 2011; 18:501-15. [PMID: 21431999 DOI: 10.1007/s12350-011-9365-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nowell M Fine
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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22
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The significance of right-sided chest leads in exercise testing for the detection of right ventricular dysfunction post myocardial infarction of the inferior wall. Int J Cardiol 2011; 146:330-3. [PMID: 19651448 DOI: 10.1016/j.ijcard.2009.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2009] [Revised: 07/05/2009] [Accepted: 07/08/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND The incorporation of right-sided chest leads (V(3)R-V(5)R) into the standard exercise testing has been reported to improve its diagnostic accuracy. The purpose of this study was to evaluate the ability of exercise testing in detecting right ventricular (RV) dysfunction post myocardial infarction (MI) of the inferior wall, using additional V(3)R-V(5)R leads. METHODS We studied 133 patients (59 ± 5 years, 81 males) with a history of inferior MI due to right coronary artery obstruction (affirmed with coronary angiography). All patients underwent an echocardiographic assessment of RV function 4 weeks after discharge and an exercise treadmill test in order to detect possible RV dysfunction. Recordings during exercise were obtained with the standard 12 leads plus V(3)R-V(5)R. RESULTS From 133 patients, 97 (group A) presented with normal right ventricle according to the echocardiographic study while the rest 36 patients (group B) presented with RV dysfunction. Maximal exercise-induced ST-segment deviation (in mm) was similar in the standard 12 leads for the 2 groups (2.1 ± 0.4 vs 1.8 ± 0.3, p = NS) while in V(3)R-V(5)R it was greater in group B (0.7 ± 0.3 vs 1.4 ± 0.4, p<0.05). Sensitivity, positive prognostic value, negative prognostic value and accuracy of exercise testing in detecting RV dysfunction were all improved using V(3)R-V(5)R (78 vs 47%, 39 vs 29%, 87 vs 75%, 62 vs 55% respectively, p<0.05 for all) while specificity was not deteriorated (56 vs 58%, p = NS). CONCLUSIONS The addition of right-sided chest leads (V(3)R-V(5)R) improves the diagnostic ability of standard exercise testing in detecting and especially in excluding RV dysfunction post inferior MI.
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Banerjee D, Haddad F, Zamanian RT, Nagendran J. Right Ventricular Failure: A Novel Era of Targeted Therapy. Curr Heart Fail Rep 2010; 7:202-11. [DOI: 10.1007/s11897-010-0031-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aziz EF, Kukin M, Javed F, Musat D, Nader A, Pratap B, Shah A, Enciso JS, Chaudhry FA, Herzog E. Right Ventricular Dysfunction is a Strong Predictor of Developing Atrial Fibrillation in Acutely Decompensated Heart Failure Patients, ACAP-HF Data Analysis. J Card Fail 2010; 16:827-34. [DOI: 10.1016/j.cardfail.2010.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 05/04/2010] [Accepted: 05/06/2010] [Indexed: 11/25/2022]
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25
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Yao SS, Weinberg C, Bangalore S, Chaudhry FA. The changing paradigm of stress echocardiography: risk stratification, prognosis, and future directions. Hosp Pract (1995) 2010; 38:26-39. [PMID: 20499770 DOI: 10.3810/hp.2010.06.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The use of stress echocardiography has undergone considerable evolution in the past 3 decades. Although stress echocardiography was first introduced as a noninvasive diagnostic tool for determining the presence or absence of coronary artery disease (CAD), it later served a prognostic role as well. The importance of stress echocardiography in risk stratification and prognosis is substantially undervalued by clinicians. The identification of patients at risk for future cardiac events has become a primary objective in noninvasive evaluation of patients with suspected or known CAD. In particular, the ability of stress echocardiography to identify patients at low (< 1%), intermediate (1%-5%), or high (> 5%) risk for future cardiac events is essential to decision making in patient management. Moreover, previous studies have conclusively demonstrated the incremental prognostic value of stress echocardiography over clinical and treadmill exercise data in predicting future cardiac events. This article presents a primarily single-center experience of retrospective and observational studies that address the current role of stress echocardiography and summarize its use for risk stratification, prognosis, and determining clinical outcomes, as well as cost-effective integration of such information in patient management decision making.
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Affiliation(s)
- Siu-Sun Yao
- Department of Medicine, Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA
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TABEREAUX PAULB, DOPPALAPUDI HARISH, KAY GNEAL, MCELDERRY HTHOMAS, PLUMB VANCEJ, EPSTEIN ANDREWE. Limited Response to Cardiac Resynchronization Therapy in Patients with Concomitant Right Ventricular Dysfunction. J Cardiovasc Electrophysiol 2010; 21:431-5. [DOI: 10.1111/j.1540-8167.2009.01634.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yang HS, Mookadam F, Warsame TA, Khandheria BK, Tajik JA, Chandrasekaran K. Evaluation of right ventricular global and regional function during stress echocardiography using novel velocity vector imaging. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 11:157-64. [DOI: 10.1093/ejechocard/jep190] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Reply. J Am Coll Cardiol 2008. [DOI: 10.1016/j.jacc.2008.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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29
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Punnam SR, Dhoble A. Right Ventricular Asynergy as a Prognosticator. J Am Coll Cardiol 2008; 51:1616; author reply 1616-7. [DOI: 10.1016/j.jacc.2007.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 12/11/2007] [Indexed: 11/30/2022]
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30
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Pellikka PA, McCully RB. Stress Echocardiography. J Am Coll Cardiol 2007; 50:1990-1. [DOI: 10.1016/j.jacc.2007.07.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 07/31/2007] [Indexed: 11/16/2022]
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